The RAMLA web pages are designed to supply you with valuable information's to sort out material motor car accident compensation cases occurred in a traffic collision on South African roads.
You will find a lot information that can help you to claim for damages or to deal with disputed motor insurance claims and even to defend you, if you face an inflated high and unreasonable claim against you.
On your way looking for a professional car accident damage assessment, to quantify and calculate your traffic accident damages occurred one of the provinces of South Africa,
Gauteng - Freestate - Northern Cape - Limpopo - North West - Mpumalanga - KwaZuluNatal (KZN) - Eastern Cape - Western Cape -
you found the RAMLA web pages giving you some ideas about the pro and cons of an independent damage investigation and what you should look on to get a reliable accident damage report, helping you to proof the material claim, against the liable party or the motor insurance company.
Even if you are located in one of the mayor cities of the country such as Cape Town - Bloemfontein - Johannesburg - Soweto - Pretoria - Polokwane - Durban - East London - Port Elizabeth - or in the wider areas around those cities or wherever in the county you are,
RAMLA (Road Accident Management & Legal Action) can support you with various service options nationwide.
Working with RAMLA will of course be the most comfortable and economic support in pursuit of a legal compensation claim, whether against a 3rd party or directed to any motor insurance company in South Africa.
Motor car accidents happen on a daily basis, and in all the South African provinces, wherever you are, in Gauteng - Freestate - Northern Cape - Limpopo - North West - Mpumalanga - KwaZuluNatal (KZN) - Eastern Cape or in the Western Cape.
In the several provinces you find differences in the level of risks, according to traffic density, conditions of the roads, day and night times, weather conditions and many more.
A motor car accident rarely does happen just out of one singular fault. Mostly more influential factors and other negligent actions must get together causing a traffic accident at all,
when driving through Cape Town or Kahilitsha, Paarl, Parow, Calvinia, Springbok, Vredenburg, as Port Elizabeth, but not just there.
In all our South African cities and even in rural areas, are risks by travelling a vehicle on public roads. Be aware that most accidents happen in your very near neighbourhood or on your daily way to or from work in your home town Middelburg, Graff-Reinet, Somerset - East or Somerset West, Grahamstown, Bisho, Zwelisha or East London, due to the facts that one who is very familiar with this routine, will not be on the alert level one should be.
You can minimise to be dragged into an auto collision, if you concentrate on the traffic, abide by the basic precautions and don't contribute negligent in driving, by let's say texting or telephoning behind the steering wheel.
But even if you live in other small towns or mayor cities such as Umlazi, Durban, Pietermaritzburg, Potchefstroom, Port Elizabeth, Knysna, Krugersdorp, Oudtshorn, Mossel Bay or Worcester you have to be aware of the danger by making your trip.
Other road users may not be up to their best abilities, be drunk for example or driving a motor car that better should not be on the road, as it is not roadworthy and so poses risks to other motorists.
Just participate in local traffic within the towns and villages as Roberson, George, Kimberly, Rustenburg or Mabopane, you can be caught up in a vehicle crash at all times, despite you may drive carefully and respect the rules of the road. The other party is always even your risk.
Minimising the probability to be caught up in a road crash, especially in bustling cities such as Pretoria, Johannesburg, Soweto, Germiston, Rustenberg, Welkom, Bloemfontein, Polokwane , Durban or Cape Town, where high volumes of motorist getting along all day, the risk to be involved in a car accident is much higher than just travelling in quieter areas as Klerksdorp or Mahikeng.
The best will be, if you are on high alert all the time you drive a motor car. Taking care of keeping proper following distances which is a very good measure not to be involved in car accidents,
when you on the roads of Kimberly, Queenstown, Beaufort West, Prieska, Upington, Vryburg, De Aar, Belfast, Bethlehem, Kroonstad , Harrysmith, Mabane, Nelspruit or Ermelo.
In huge metropolis as Johannesburg or Cape Town where you deal with rush hours when commuters get to and from work in the morning and evening hours, the danger to be trapped up in a motor car accident are explicitly higher as to other traffic times.
If you have been unlucky dragged into an auto accident caused by another one or more motorist who drove negligent, not abiding the rules of the road or even careless and subsequent suffered material damages to your motor car, you want that the liable party pay compensation you for losses.
If you do have any problem with a South African Motor Insurance, Broker or Claim Adjuster in attending your claim, just let us support you.
Motor car accident disputes with the insurance companies, regarding a compensation claim, directed to SA motor insurance company, are common in South Africa. Lots and lots of claim disputes arise on a daily basis.
There are lots of terms on what reasons South African motor insurance companies reject, deny or repudiate to attend a damage claim.
Firstly seen, there are arguments citing a breach of the insurance terms, meaning the car insurance company tells you, that you failed to comply with one or another term of your policy duties. A breach of the motor insurance policy terms you can be accused of are, dishonesty or short payments, negligent behaviour that you violate the rules of the road by telephoning as driving, being under the influence of alcohol while driving, or having an not roadworthy vehicle illegally on the road, up to the argument that you are not a legitimate driver, or did not disclose that the vehicle is relocated from the area of your residence to another for a longer period of time and unfortunately much more.
They say you have withheld them the opportunity to calculate the risk insured with you to the true circumstances and therefore reject the claim.
Facing an insurance dispute with a motor insurance and having the claim dismissed, which is an easy way for the car insurance claim negotiator in honouring his task to reduce compensation claims to the absolute minimum, by rejecting a claim at all, if there is the slightest possibility to do so.
We don't say that this is what you always need to expect from your insurance company, but as soon you are classified as a more severe risk, resulting out of claims before, it will be more likely facing them to get away from your new claim. A so called - good risk - if you did not claim before but paid the premiums for some time, will make the insurance company to be more generous not to look into all they probably can do, not to lose you as you are still deemed an acceptable risk.
Other car insurance problems that may lead to a dispute can easily be caused by the motor vehicle damage assessment. If the findings of the damage and stated in the assessment report are not correct, you need to oppose and combat the stated outcome. Most often the insurance company take the - often party friendly - findings of a vehicle assessment as basis for any settlement offer and frequently even reduce such numbers stated in the assessment report by standard approaches to certain percentages etc.
Luckily you don't need to accept all your or the insurance company of a 3rd party tells you, but you need to be prepared to repudiate the arguments brought forward and proof them wrong.
RAMLA handled lots of such claims for clients/members to be compensated full and fair.
Only a part of those insurance claim disputes are referred to the RSA ombudsman for short term insurance.
As the ombudsman can only deal with car insurance claims that arise out of a contractual - motor insurance policy - dispute between the insurance company and the insured and is not dealing with 3rd party insurance claims.
Due to a release from the ombudsmen's office, hundreds of claim disputes are coming in daily and times to attend an individual complaint became longer and longer. The same publication confirms that the ombudsman's office is understaffed to deal with the rising numbers of insurance claim disputes.
A noticeable number of motor insurance disputes cannot be dealt with by the ombudsman. These are the 3rd party claims where the victim claims from the perpetrator.
Any dispute that derives from a car accident claim against the liable party and/or the motor insurance company on behalf of the insured, to compensate the motor vehicle accident damages must be dealt with in the appropriate manner and according to the law applicable.
If your case will be one of those where the motor insurance company reject, deny or do not offer fair and full motor accident compensation, you should enter into a dispute resolution with the motor insurance company. But don't expect too much. It will be a hard and you need to be persistent.
This is by far not an amicable claim. Most differences with a South African motor insurance company are based on the findings of the motor insurance vehicle damage assessment. Lot of those party friendly damage assessments are not acceptable for the victim of an accident and can be caused on a number of issues dealt with in the motor vehicle damage assessment report.
If you find yourself in such a case, you should not hesitate to look for experienced support as it will be not a walk in the park to finally get the motor insurance pay what is fair and correct.
To our experience the insurance claim negotiator or whatever the tittle will be, may be stubborn insisting on the position he is directed to follow, even if very obviously being wrong, the tactic is that you simply give up to end the saga and cut your losses.
But is that really the way to go, accepting a significant shortfall of compensation only to end the story?
You can always consider mandating RAMLA with your motor insurance claim dispute, for professional, effective and economically very favourite conditions.
Insurance companies offer you motor car insurance cover, to take over the risk for car accident damage compensation payments, when the insured is involved in a motor car crash.
When a motorist must compensate a 3rd party for auto accident damages or have to repair own vehicle damage, the insured can claim from his/her insurance policy according to the individual schedule.
There are a lot of different insurance companies in South Africa and all offering a variety of insurance cover, thought to different terms and condition in specified insurance tariffs.
Watching the insurance company's adverts offering its insurance cover, one must be under the impression that nothing is easier, cheaper and more favourable, as to have motor car insurance.
Indeed motor car insurance is a very useful tool, but the insured must be on alert all the time to keep all records up to date and always have the premiums paid in time.
Motor Vehicle Accident
Facing challenges with motor car accident issues in South Africa?
RAMLA will be the solution,
demanding compensation, resolving disputes, defending against inflated or unreasonable claims,
in all sectors of vehicle accident damage compensation problems.
Lot of problems may arise, if you give your insurance company a reason to decline or reject a claim, despite you paid all up to date trust to be on the safe side if any car accident claim comes your way.
A variety of reasons for an insurance company, most often are based on those terms and conditions you agreed upon, when you are not taking the small and seemingly unimportant things serious and comply to all times.
For example, if you fail to inform your insurance company of the relevant regular driver, there will a high possibility that your claim may be rejected on such argument.
It will be good for you, if you try to have proof of what and when you submit something relevant to your insurance company.
Generally a motor car insurance policy, to be covered for car accident damages, either for 3rd party claims or even insured comprehensive (paying to cover your own auto crash damages according to the tariff chosen), will be a good thing, or even better that all motorist in public traffic have to have at least a 3rd party cover for vehicle accident damages. Ideally this should be obligate for all motorists in South Africa, before driving in public traffic.
As there is a culture of competition by South African motor insurance companies, for the lowest tariffs/premiums to pay haveing the motor vehicle insured, but still offering excellent service when there is a need to claim from such motor car accident insurance cover must not mean you may be inconvenient surprised when you are in the hope to have sorted out all you wanted, not struggling if you once be involved and liable for car accident damages.
For those who are critical enough to see the interdependence between low premiums and generous compensation, it will not be a surprise if the premiums are low and the compensation should be high, will be not the rule as rather the exception.
Before you insure your motor car it must be looked onto the details carefully prior choosing a motor insurance tariff or policy.
Enabling the insurance company to offer low prices for such motor insurance cover, there will probably be the need of different tariffs with altered covers, they may say to you - tailored just for you.
That may lead to exclude things; one believes should be covered under the insurance plan at all, but may be not under the specific insurance policy offered.
But when it comes to a motor vehicle accident claim launched to your insurance company, some insurance companies or its brokers try down scaling the risk covered.
The claim negotiator in charge will look into your insurance plan, in order to find loopholes and subsequent to lower its payments for claim compensation.
Insurance companies more often than not, apply strategies to avoid or minimise such compensation payments and it can be a challenge to have the claim accepted, to the conditions that enables the victim of motor crash damages to repair the vehicle professionally.
Rarely one will be paid out what have been initially claimed for and being suitable to be full and fair compensated for traffic accident damages, without putting high pressure and good arguments on to such insurance brokers or claim administrators that handle the claim on behalf of the insurance company.
Even the Ombudsman for the short term insurance recommends putting pressure onto the insurer, when no amicable settlement can be reached.
Lot of South African insurance companies have in common, not to be very active if a claim is launched. Some manage to be very silent and/or most often have arguments in place to downscale the damages or shift liability to other parties in terms trying to blame the other party to be partial liable, or use other arguments to get around the compensation payment.
All those measures must not necessarily be the right ones, but sometimes suitable to confuse the claimant.
It had even been observed, that South African insurance companies, represented by the claim management, argue against its own terms and conditions and simply apply to positions that are not in line with your individual insurance scheme.
Such things can be the argument to reject a claim.
Other conflicts can arise out of an insurance vehicle damage assessment, i.e. finding the tire profile of one tire too low or apply other terms that might be suitable to dispute the insured car has been roadworthy to the time of the accident.
Disputes about the market value and applicable repair costs are very common, therefor the insurer make your vehicle a "write off" claim. Such "written off" claims must be looked on very carefully and where possible it should be rebutted as such. A claim called a total loss can easily end up to your disadvantage and most often you need support to be able to rebut such classification successful.
One should be aware, that the slogan used by South African motor insurance companies, to pay out "immediately" . . . . . if the claim is approved. This final acceptance is needed, before they pay, when you claim.
You need to go through the full process to arrive at an approval that suits your claim being able to repair the car accident damages professionally and to manufacturer's standards.
This can take time and being sometimes a challenge. Unfortunately that can take weeks or months; eventually you even need to go to court, to sue your own insurance company to pay.
If you are in dispute with your own insurance company, you can relate the dispute to the Ombudsman for short term insurance in South Africa for review.
But don't make a mistake believing this will be quick and without hassle for you. The Ombudsman's office is poorly stuffed according to its own statement and it will take probably some months before a review is finalised.
Motor vehicle accidents happens every day on public roads, often causing damages to property
Utilise the affordable professional solutions RAMLA offers clients in South Africa, to solve such repercussions.
Car Accident Claim rejected
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Your first stop solution for any MVA problems - in South Africa
Declined disputed or unsettled Motor Insurance Claims
- the process of challenging it -
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Comprehensive Motor Insurance Cover
Claim rejected, denied or dismissed?
Once putting a claim in to your motor insurer, based on a comprehensive cover, the expectation will be having the claim accepted and paid fair and swiftly.
Unfortunately that will not always be the case, as a number of factors may come up to let the Insurer decline a claim.
There are always some early warning signs, which should ring alert, if an insured will be aware of those indicators. Commonly when an interested reader study the RAMLA web offer, the issue in question is already be dealt with, in one or another way and mistakes can be made as easy as they may have been avoided.
Many warning signs exist, but always being individual, as to the particular matter. Those signs emanate from violations of Insurance policy terms & conditions, having an accident shortly after concluding the policy, the accident happen at night or under other "suspicious" circumstances, damage examination rise eyebrows and more as, i.e. frequent claims been reported in a short period of time.
Decline reasons are mostly given only in Headlines, followed by a short citation of the terms. The true reasons of the decline are most commonly not revealed in detail. A decline however can only be challenged successfully, if the allegations are known and suitable evidence to rebut those provided.
Once the Insurer send the damage assessor, loss calculator or any other investigator, insured parties should know what they do, acting collaborate with the Insurance agent. There are many small issues that may not be regarded as important, in due course of the investigations and a honest insurance client always strives to contribute and assist with the true circumstances. But there may be some traps, commonly unaware to the insurance client.
Questions may be formulated to direct an answer in a way the Interviewer do like it to be answered, suggestive questions, as those agents are paid to make sure that the damage compensation mustn't be paid by the Insurer, should there be any reasonable issue to decline a claim, as a result of those investigation's.
In the regard of the difficulties above, it will be advisable to act informed and take professional advice, in an early stage and not if it's too late and mistakes, avoidable been made.
|| Free first case analyse!
Dear valued reader, checking out the RAMLA car accident compensation platform; obviously you do have some traffic accident damage issues to solve.
Find out more about a free check of your particular case issue and advice, by following the link.
If in due course of the examination and validity of an insurance claim, a decline is expectable and/or the matter not been entertained, one must initially look on the reasons for the possible repudiation of the claim, enabling to argue in the correct way, before a negative decision is made.
A number of declines are based on violation of terms & conditions to the insurance contract. It must be emphasised that not all claim declines, based on violation of terms, will be fair and sufficient to eventually deny the claim. Lots of arguments don't bear enough evidence that it can stand a review, even if so called expert investigations are cited to be the backbone of the decline.
Confronted with such declines and strongly believing the decision is unjust, an Insurance client should not hesitate to challenge the decline, sometimes more effectively with the right and knowledgeable adviser or representative to the side.
RAMLA is a specialised expert in such motor Insurance matters/problems/challenges and can gladly act for a client, under a given and paid mandate, to solute matters professionally.
Your specialised expert to sort out MVA matters
Professional - competent - swift - decisive and affordable
Declined - rejected - not accepted:
Claim against own comprehensive motor insurance policy
Declining or apportioning a claim for motor vehicle or car accident damages is just too easy. Any such decline or other disputes about the cause and liability for the traffic accident, may cause some problems to sort out. RAMLA is a specialised expert for MVA solutions sorting out or resolve problems which ever type they may be.
You are welcome to RAMLA. Login on to a web page and looking for information's how South African motor insurance companies act, indicates that you do have a problem already, with one of those companies.
Differences or disputes can arise easily and may be based on a lot of different aspects or factors.
Sometimes a compensation claim, to get your car accident damage paid for, may get along smoothly and without hassles, but certainly a high number of disputes with South African Motor Insurance Companies, arise on a day to day basis.
Motor Car Accident, in South Africa?
You want your car accident damages being paid for and receive your material vehicle accident damage compensation for destructions, suffered in a traffic accident on South African roads?
You are welcome to contact RAMLA to receive free advice after a free accident fact check to determine your position.
Contact RAMLA (Road Accident Management & Legal Action), tell us your Motor Vehicle Accident story, the issues of concern, the problems you detect or face and get a free check and advice how to proceed.
We will check and analyse your individual case and revert to you - most of the time in short circle -.
For best results contact us by email initially, give us an idea of the incident, attach one or two pictues of the damages or relevant situation, the extend or value of the damages suffered - if already assessed -.
In case of an Insurance claim decline, supply us with a copy of the repudidation letter, of give us the reason for the rejection and name the Insurance Company.
Should you like talking to us (phone contact displayed below), do that after the initial email briefing, but keep in mind even we need some time to check about your matter first.
You are welcome to utilise such valuable absolutely free inital advice
RAMLA can be the solution in MVA matters
Do you know that RAMLA is a specialised expert in handling and enforcing or defending all kind of MVA (motor vehicle accident) matters, pursuing motor car accident compensation claims, Insurance dispute resolutions, for its clients - effective - professional - decisive and resolute, to best and affordable fees.
As you probably have recognised on our comprehensive web information platform, we do know what we are taking about.
We do invite anyone in South Africa, facing an MVA (motor vehicle accident) problem, to contact us for a first - free - analyse of your particular matter and get initial advice how to proceed.
As a specialist in traffic accident recovery actions, we act for clients/members in the relevant manner, but based on a paid mandate or membership, if a need of practical support arises.
We do offer a free first advice, to determinate your case and give you a direction how and what may be the way forward, in order to build confidence with a potential client.
As professional specialists, in charge of acting in motor accident damage claims in South Africa, we offer a well performing, decisive and demanding claim pursuit, at affordable fees.
It's so easy contacting us by email.
The effective way will be sending an email containing the nature, damage and problems detected. Once sent through to us, we will study the matter and after analysing the facts, we get back to you by email (most commonly within about 3 hours), with the result and advice,
- free of charge.
If you like to explain your problem to our claim manager on duty, you are welcome to contact us by phone for an initial briefing on cell 076 770 3179 (standard rates apply).
For best results: dont't just call, once you took notice of the opportunity!
First think what you like to get accross, best file it as email and call therafter.
For reasons to convince you not just calling immediately, please follow: how to contact RAMLA successfully.
It will be much more effective; if we do get a briefing of the matter via email, before a telephone call, so we will be prepared answering your questions.
* please note that a practical claim pursuit will not be free of charge and comes with a paid mandate, but at reasonable and affordable fees.
Car accident compensation claims for damages, may cause some headache,
in South Africa.
RAMLA can be the solution to sort out MVA problems.
Not everything in a compensation action goes smooth and the way wanted, as we are confronted with numerous possible challenges.
RAMLA is a specialised expert in material car accident damage claims,
demanding, enforcing compensation actions, supporting disputes with Motor Insurance Companies or its agents, work in Ombudsman's review cases, or defend a motorist against unreasonable or inflated compensation claims.
Contact RAMLA to analyse your case, and get a free opinion where you stand and what to do next. You can contact RAMLA 7/24 and receive a response soon.
It's so easy, just e mail your story and attach what you got to make the RAMLA claim manager understand your problem.
Just draft a brief report of what had happen and send it (use this mail link) to RAMLA for free analyses and you will receive a reply soon.
Contact us now and let us know how we can help you?
email us your story and details to firstname.lastname@example.org for a free first analyse and advice.
RAMLA offers full legal support to solve car accident claim, a comprehensive claim preparation and action to enforce compensation, all the way up to a court case.
Claim declined: on reasons violating the terms & conditions
Violating the terms and conditions of a motor insurance policy can be in many ways, as an insured needs to adhere to all such terms on the dot, before there is an investigation aimed to decline the claim.
If found just one little violation or accusation of noncompliance, it may be good enough to enable the Insurer to decline a client's claim. The insurance claim adjuster does know the burden a client will face challenging a negative decision or a full decline.
Even offered the opportunity to have a negative claim decision reviewed by the Ombudsman for Short Term Insurance (OSTI) will not give much certainty, if a complainant (insured client) does not address the matter correctly and challenge the matter, based on facts that are presented to the Ombudsman properly.
For further details a claim is denied on violation of terms & conditions following an investigation,
More issues - follow the link or scroll down
Violations of terms and conditions and consequential claim denial, may arise from:
Payment is not up to date or not deducted from the account in time, despite arrangement and funds in the accounts, especially important if a policy has just been concluded and the newly insured car been taken into public traffic, before deduction or payment of the first premium.
The Insured is alleged to have not disclosed all information the Insurer expect to be disclosed, such as accident history, financial defaults etc., of which some doesn't have any correlation to the cover.
The area of operation of the insured vehicle changed, not only for a short period of time and hasn't been reported as update of data, as well as other similar updates required permanently, maintaining cover.
The accidental driver isn't a registered driver in the policy, but alleged effectively being the regular driver of the vehicle, probably insured as a second's or third car, for the policy holder.
The insured haven't complied with the Investigations and not disclosed all information's required, such as the providers telephone records, tracking device data etc.
The car hasn't been roadworthy, i.e. as to tyres with low profile or similar allegations.
The Insured has violated the duty of careful and responsible driving and alledged having driven at excessive speed, drunk driving, or other comparable allegations.
The client has not been honestly disclosed all relevant factors in the particular impact.
Once faced with one of the above conflicts, the assistance of experienced advisers are highly recommended, before entering into a dispute with the Insurance company, or even if that had happen and matters are to be reviewed with the Ombudsman for short term Insurance (OSTI), in order avoiding formal mistakes or missing out presenting further evidence or not highlighted the matter in a sufficient manner, experienced support will pay.
RAMLA (Road Accident Management & Legal Action) is such an experienced adviser and act for clients/members in appropriate manner, attempting to get the dispute solved. Contact US.
You found the RAMLA web pages by research for answers as you probably do have any kind of problems with motor car accidents in South Africa. The comprehensive web offer will give you a lot of inside and you should look on the Keyword Search for the selection of the topping you want to know about.
Let me say, that dealing with road accident compensation matters is not always easy and it can be of advantage for you to get active RAMLA claim support to sort out what is on stake, professional decisive, convenient and most affordable.
RAMLA will be your one-stop car accident claim service in South Africa
contact us for support in recovery of your MVA damages
Claim declined: short after conclusion of the policy
Concluding a new policy to cover a new or 2nd hand motor car, should be done early and before the vehicle is taken onto the roads.
It is crucial that the newly insured items premium should be paid over to the insurance company, and having proof of the payment of the first instalment, before entering public traffic.
A motorist who is, newly covered with car insurance, should not trust any dealers or brokers promises, the vehicle will be - effectively insured - once the cover is formally concluded. Concluding the cover doesn't mean that the cover is in effect at the same time, as cover always needs having the premiums paid up.
A newly covered car owner should even not take the risk and believe he/she is actually safe and properly insured, as it has been agreed paying the premium by debit order, which should be deducted by the Insurer asap. But even the best administration cannot effectively deduct the account of a new client for premiums on the same day as the policy is concluded.
That effectively creates the risk of not having cover in the time, before the first instalment is paid. If i.e. a brand new car is insured and bad luck leads the owner driving the car before the first instalment is effected, and the worse case, a motor collision happened, it can be devastating expensive, if the insurance decline a claim, as to the matter the cover isn't active, even if the premium has been effectively deducted from the clients account, only one day after the accident.
A claim against a valid an paid up policy can unexpectedly be denied in some instances, if put forward short after commencement
There are even more risks as a policy has been established recently, even if the premiums for the first and more instalments been paid, that a claim reported in a shorter period after the establishing of the cover may be declined, on reasons that may let someone wonder, if those factors couldn't have been checked in a short period after the commencement of the cover, or even before a cover could be established at all.
Those reasons to decline a claim are most commonly based on wrong or insufficient information, revealed in the application for the policy cover, such as accident history or previous financial defaults etc.
In all regularity, the insurance company will not verify a new application for motor insurance cover, once the application is made and submitted, but will start to look into the details, if a claim against the policy is made short after the policy has been established, paid up or not. Short term cannot be quantified exactly and may vary, but if a claim is reported after 4 to 6 weeks after commencement of the policy, the Insurer will do so.
The insurance do have methods to verify a claim history or a financial default, as well as other material matters at its disposal. Unfortunately they don't apply them, before a claim is reported, just taking in the premiums and hope for the undisturbed development of a new cover.
The very bad thing for an insured however is, that the client is under the impression to have a valid motor insurance cover, despite his/her application may be formulated in favour of a successful application, being confronting with a huge burden, if an accident occurs for which either 3rd party liability is to be taken or own property had been damaged.
Claim declined: The accident happened late evening, at night or to suspicious circumstances
Reasons declining a motor insurance claim may even emanate from detected unusual circumstances. Those issues can be, the accident happened late evening, in the night or early morning, a time a regular motorist will be at home.
The accident report will be scrutinised and if some initial doubts of an insured's careful and responsible driving come up with the claim administrator, a more in depth investigation will follow. Such investigation will be performed either by a damage assessor or separate forensic or scene investigators up to specialised accident analysts.
Once such investigations are announced and scheduled, an insurance client should know that not all such investigations coming up with fair and just results. Therefore someone to be interviewed to the accidental circumstances, should know what must be expected and one should be prepared to present the true story, in the right way.
It has been reported, that some assessors or investigators work with suggestive questionaries' and anyone must be aware that false interpretations can lead to a rejection of the compensation claim.
Next to the interview with the driver/owner of the vehicle, the person in charge for the examination will do own investigations, looking for witness or other forms of negative evidence, which may be used declining a legitimate claim.
Even detailed expert assessments and analyses taken as the basis to decide on a claim, must not always been correct and fair. Many of those reports aren't credible, but still utilised to decide on a claim, as a claim admin doesn't always have the knowledge and qualification to evaluate the case and the evidence.
Unfortunately some motor insurance companies, declining a claim based on such assessments, just give an insured some extracts out of the reports in the decline letter, in order to proof the repudiation reasonably, but elect not to disclose the full report, declaring it preferential information.
This can certainly not be accepted and needs to be challenged.
The true value of an investigation/assessment will only come to light, once the full report can be revised by someone knowledgeable to verify the quality, fairness and validity.
Declined: due to damage assessment and/or Investigations
After a more serious accident claim has been put to the Insurer for perusal, commonly a damage assessor/calculator will be sent to examine the damages motor car.
The damages will not just be checked in terms of repair needs, but even if the insured vehicles damages are plausible to be from the impact reported and further how the accident unfolded, who was the driver and more.
Assessors frequently checking motor car accident damages, do have ample experience/training and can recognise or suspect from certain damage scenarios, that it will be opportune to look deeper into the particular matter, as probably violations of insurance terms may be at stake.
The report to the Insurance may trigger a more in depth investigation in the details of the matter and can bring difficulties to the claiming party, if matters will be seen as a non-compliance with one or another part of the insurance policy, leading to a repudiation of the claim.
Those alleged violations as the breach of insurance policy terms & conditions, can be of minor seriousness and often not even linked to the particular traffic accident.
If the driver hasn't been the one registered with the policy terms as the regular driver, it may trigger an investigation who indeed will be the regular driver, the one most commonly driving the vehicle.
The regular driver it is said does has his own risk profile and may have had the need to adjust premiums.
The decline can be, the policy holder didn't inform the Insurer and thereby withhold him the possibility to check the risk again and adjust premiums.
Interestingly a number of Insurers do conclude a contract with a client in order to have a longer term relationship and not only for a month or so. If it comes to the term and constructed obligation to inform the Insurer of the change in the main driving person, they sometimes refer to the policy as to be a monthly contract.
That may well be in regard of validation, if premiums aren't paid. But a longer term insured, do not assume that the regular driver change must be reported for each and every month, if a change will be.
That means, if an insured has a policy for years, be the regular driver at all, but lend the car to a family member or friend for a period of time, i.e. to serve other family members in unpredictable circumstances, such as hospitalisation of a family member that needs to be visited, and such will take the best part of a month, not reported to the insurer, bears the risk of a decline, just on such a reason, despite the insured intend to drive just this lend vehicle, as a regular driver in daily traffic, just after return of it.
|| Finding yourself in a dispute, with the motor insurance company think twice if you can afford not to utilise experienced external dispute solution support.
The Insurance handle such matter as a profession, you may be involved in a car accident leading to a dispute, once in 10 years. Contact RAMLA for support
Similarly, if the accident happened at a location not near the registered area of regular driving, it may be suspected that the area of risk has changed and not reported. Even the change of the area of use, may have different risks in daily traffic, such as a busy metropolis or a rural quite area, which even needs the Insurer adjusting premiums. Missing out can cause the risk of loss of cover.
It has been seen, that even a not reported change of residence, just into another suburb of the same town, with commonly same traffic risks, has been attempted and utilised to decline a claim.
Having a valid cover, will need complying with many aspects, no insured ever think it's an important matter, so it may not even be in an attempt to avoid adjustment of premiums, but simply not regarded as so important.
The Investigator does not only look into serious matters, but in such above as well, finding arguments to allege and suggest declining.
Dishonesty is another matter not to forget. Any reports, phone calls etc. are regularly recorded. Should there be any inconsistence with other sources of information or contradictory statements, an insured may be accused to be dishonest. Dishonesty, as well as non-participation in investigations, are reasons for declining a claim.
Declined: after frequent claims has been put forward
In matters where an insurance client is unlucky to be involved in more than one car accidents in a shorter period of time, some eyebrows will be raised about the risks insured. Such a so called "bad risk" will not be the favourite client of any Insurance Company.
A frequent claimer must be prepared to pay higher excess, premiums or even have the policy cover revoked or cancelled.
This has reportedly been the case, even if all the reported claims haven't been caused by the insured, as always the 3rd party been liable for the causation of the matter.
There will be little to do, if an insurer chooses the right to cancel a policy, as to terms & conditions to own discretion.
What however must be made sure and prevented, will be that the Insurer don't "blackmail" the unlucky ex insured, so that other companies checking the risk if a new contract is required, may not even offer cover such a frequent risk, which isn't fair, as to the innocence of the motorist in all or most of the cases.
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Conditions for free first claim analyses:
RAMLA offers first free analyses of your motor accident case, in order to enhance your confidence.
Therefore some data and material will be needed to submit to RAMLA for an individual reply. In such circumstances, RAMLA will have the free copyright to publish case information and of photographs on our web pages, designed to inform others about real instances, without exposing your private data.
The content of the RAMLA web pages has been put together with outmost care and will be improved constantly. The information given is designed as information platform to solve motor car accidents problems in South Africa.
Any advice taken from the web pages or drawn from a free first analyse of your individual case, does not constitute any legal advice.
RAMLA cannot be held liable for any damages on whatever reasons out of the above, if the information given will be wrong, incomplete or misinterpreted.
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